scholarly journals Local Delivery and Glioblastoma: Why Not Combining Sustained Release and Targeting?

2021 ◽  
Vol 3 ◽  
Author(s):  
Claire Gazaille ◽  
Marion Sicot ◽  
Patrick Saulnier ◽  
Joël Eyer ◽  
Guillaume Bastiat
Keyword(s):  
Gold Standard ◽  
Standard Treatment ◽  
Tumor Resection ◽  
Local Therapy ◽  
Standard Of Care ◽  
Current Treatment ◽  
Therapeutic Strategies ◽  
Post Surgery ◽  
Major Benefit ◽  
Local Strategy

Glioblastoma is one of the most aggressive brain tumors and is associated with a very low overall median survival despite the current treatment. The standard of care used in clinic is the Stupp's protocol which consists of a maximal resection of the tumor when possible, followed by radio and chemotherapy using temozolomide. However, in most cases, glioblastoma cells infiltrate healthy tissues and lead to fatal recurrences. There are a lot of hurdles to overcome in the development of new therapeutic strategies such as tumor heterogeneity, cell infiltration, alkylating agent resistance, physiological barriers, etc., and few treatments are on the market today. One of them is particularly appealing because it is a local therapy, which does not bring additional invasiveness since tumor resection is included in the gold standard treatment. They are implants: the Gliadel® wafers, which are deposited post-surgery. Nevertheless, in addition to presenting important undesirable effects, it does not bring any major benefit in the therapy despite the strategy being particularly attractive. The purpose of this review is to provide an overview of recent advances in the development of innovative therapeutic strategies for glioblastoma using an implant-type approach. The combination of this local strategy with effective targeting of the tumor microenvironment as a whole, also developed in this review, may be of interest to alleviate some of the obstacles encountered in the treatment of glioblastoma.

scholarly journals Endoscopic Resection of Sinonasal Hemangiopericytoma following Preoperative Embolisation: A Case Report and Literature Review

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Georg J. Ledderose ◽  
Donata Gellrich ◽  
Markus Holtmannspötter ◽  
Andreas Leunig
Keyword(s):  
Gold Standard ◽  
Standard Treatment ◽  
Tumor Resection ◽  
Embolic Agent ◽  
External Approach ◽  
Endoscopic Techniques ◽  
Tumor Entity ◽  
Benign Nature ◽  
New Treatment ◽  
Radical Surgical Resection

Objectives. Hemangiopericytoma is a rare tumor entity deriving from pericytes. Less than 5% of hemangiopericytoma occur in the nasal cavity and are characterised by a rather benign nature with low tendency of metastasis. However, as the recurrence rate in the literature ranges from 9.5% to 50%—depending on the length of followup—a radical surgical resection is considered as the gold-standard treatment. Only a few years ago, a wide external approach, usually via lateral rhinotomy or Caldwell-Luc, was performed. Endoscopic techniques were regarded as appropriate for small low-vascularised tumors only.Methods. We present the case of a 64-year-old patient with an extended sinonasal hemangiopericytoma, who was successfully treated by an endoscopic controlled endonasal tumor resection after embolisation with Onyx. Further, to support the new treatment option, we review the literature concerning all features of sinonasal hemangiopericytomas and their therapeutical management.Results/Conclusion. Onyx, which has not been described in the context of hemangiopericytoma yet, is a very effective embolic agent for a preoperative embolisation of sinonasal hemangiopericytoma allowing a safe endoscopic surgery.

Treatment strategies after failure to reversible tyrosine kinase inhibitors (rTKI) in EGFR mutant (mut) non-small cell lung cancer (NSCLC) patients (p): A retrospective analysis of 41 Spanish p.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19089-e19089
Author(s):  
Jordi Remon ◽  
Teresa Moran ◽  
Diego Alcaraz ◽  
Laia Capdevila ◽  
Rut Porta ◽  
...  
Keyword(s):  
Kinase Inhibitors ◽  
Acquired Resistance ◽  
Treatment Strategies ◽  
Local Therapy ◽  
Stage Iv ◽  
Standard Of Care ◽  
Therapeutic Strategies ◽  
Egfr Mutations ◽  
First Line Therapy ◽  
Egfr Mutant

e19089 Background: Different therapeutic approaches have been used in the clinical setting in NSCLC p harbouring EGFR mutations progressing to rTKI, although the standard of care in this situation is still not well established. Methods: A multi-institutional database from four different centers in Spain was review to identify EGFR mut p with acquired resistance to rTKI in order to evaluate the therapeutic strategies after rTKI failure and the effect on the post-progression survival (PPS) of these treatments. Results: 41 p with acquired resistance to rTKI were identified: 63% female; median (m) age 62 ±11 yrs; 95% Caucasian; del19 76%, never or light former smokers 100%; 90.2% adenocarcinomas; 51 % received TKI as first line therapy; 85% were initial stage IV .mPFS for the rTKI was 8.4 months (mo) and mOS was 29.7 mo for the entire population. P were treated with a median of 2 therapeutic strategies after the rTKI failure. 6 therapeutic strategies have been identified. As immediate approach, 16 p were switched to chemotherapy (CT) with a mPPS of 3 mo. 9 p were switched to an irreversible TKI obtaining a mPPS of 3.9 mo. rTKI plus other drug was maintained in 11 p: rTKI plus CT in 9 p with a mPPS of 4 mo and rTKI plus other drug different to CT in 2 with a mPPS of 2 mo. Despite the progression, rTKI was maintained in 2 p considered slow progressors and local therapy, in addition to the rTKI, was administered in 3 p with oligoM1progressive disease obtaining a mPPS of 1.4 and 36 mo, respectively. 8 p were treated sequentially with ≥5 strategies. These p attained a mOS of 27.7 mo. Conclusions: The combination of different strategies when treating EGFR mut p after rTKI failure may impact the survival especially when p are candidates to receive some of this treatments sequentially. These strategies may reflect different subsets of EGFR mut disease.

Overexpression of microRNA-21 in the Serum of Breast Cancer Patients

MicroRNA ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. 58-63
Author(s):  
Batool Savari ◽  
Sohrab Boozarpour ◽  
Maryam Tahmasebi-Birgani ◽  
Hossein Sabouri ◽  
Seyed Mohammad Hosseini
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cancer Progression ◽  
Tumor Resection ◽  
Tumor Grade ◽  
Healthy Controls ◽  
Breast Cancer Patients ◽  
Serum Samples ◽  
Post Surgery ◽  
Polymerase Chain

Background: Breast cancer is the most common cancer diagnosed in women worldwide. So it seems that there's a good chance of recovery if it's detected in its early stages even before the appearances of symptoms. Recent studies have shown that miRNAs play an important role during cancer progression. These transcripts can be tracked in liquid samples to reveal if cancer exists, for earlier treatment. MicroRNA-21 (miR-21) has been shown to be a key regulator of carcinogenesis, and breast tumor is no exception. Objective: The present study was aimed to track the miR-21 expression level in serum of the breast cancer patients in comparison with that of normal counterparts. Methods: Comparative real-time polymerase chain reaction was applied to determine the levels of expression of miR-21 in the serum samples of 57 participants from which, 42 were the patients with breast cancer including pre-surgery patients (n = 30) and post-surgery patients (n = 12), and the others were the healthy controls (n = 15). Results: MiR-21 was significantly over expressed in the serum of breast cancer patients as compared with healthy controls (P = 0.002). A significant decrease was also observed following tumor resection (P < 0.0001). Moreover, it was found that miR-21 overexpression level was significantly associated with tumor grade (P = 0.004). Conclusion: These findings suggest that miR-21 has the potential to be used as a novel breast cancer biomarker for early detection and prognosis, although further experiments are needed.

Reconstruction of the Mandibular Condyle

2021 ◽  
Author(s):  
Spencer R. Anderson ◽  
Kaitlynne Y. Pak ◽  
Aurora G. Vincent ◽  
Adrian Ong ◽  
Yadranko Ducic
Keyword(s):  
Gold Standard ◽  
Traumatic Injury ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Mandibular Condyle ◽  
Facial Aesthetics ◽  
Mandibular Growth ◽  
Alloplastic Materials ◽  
Technological Advances ◽  
Integral Structure

AbstractThe mandibular condyle is an integral structure in the temporomandibular joint (TMJ) serving not only as the hinge point for mandibular opening, but also facilitating mandibular growth and contributing to facial aesthetics. Significant compromise of the TMJ can be debilitating functionally, psychologically, and aesthetically. Reconstruction of the mandibular condyle is rarely straightforward. Multiple considerations must be accounted for when preparing for condylar reconstruction such as ensuring eradication of all chronically diseased or infected bone, proving clear oncologic margins following tumor resection, or achieving stability of the surrounding architecture in the setting of a traumatic injury. Today, there is not one single gold-standard reconstructive method or material; ongoing investigation and innovation continue to improve and transform condylar reconstruction. Herein, we review methods of condylar reconstruction focusing on autologous and alloplastic materials, surgical techniques, and recent technological advances.

Time to abandon the old dictum of delayed laparoscopic cholecystectomy after acute cholecystitis has settled in Caribbean practice

2021 ◽  
pp. 004947552110100
Author(s):  
Shamir O Cawich ◽  
Avidesh H Mahabir ◽  
Sahle Griffith ◽  
Patrick FaSiOen ◽  
Vijay Naraynsingh
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Gold Standard ◽  
Standard Treatment ◽  
Gallstone Disease ◽  
Acute Attack ◽  
Early Laparoscopic Cholecystectomy ◽  
Delayed Surgery ◽  
Delayed Cholecystectomy ◽  
Delayed Laparoscopic Cholecystectomy

Although laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis, many Caribbean surgeons are reluctant to operate during the acute attack. We collected data for all consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis from January 1 to 31 December 2018. Delayed cholecystectomy was done >6 weeks after acute cholecystitis settled. We compared data between early and delayed groups. Delayed laparoscopic cholecystectomy was performed in 54 patients, and 42 had early laparoscopic cholecystectomy. Delayed surgery resulted in significantly more complications requiring readmission (39% vs 0), longer operations (2.27 vs 0.94 h) and lengthier post-operative hospitalisation (1.84 vs 1.1 days). Caribbean hospitals should abandon the practice of delayed surgery after cholecystitis has settled. Early laparoscopic cholecystectomy would be financially advantageous for our institutions, and it would save patients recurrent attacks of gallstone disease.

scholarly journals Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient

2021 ◽  
Vol 14 (5) ◽  
pp. e241540
Author(s):  
Jaekyoung Lee ◽  
Dong Cheol Lee
Keyword(s):  
Elderly Patient ◽  
Cerebrospinal Fluid ◽  
Gold Standard ◽  
Standard Treatment ◽  
Nasolacrimal Duct ◽  
Intravenous Antibiotic ◽  
Duct Obstruction ◽  
Orbital Wall ◽  
Silicone Intubation ◽  
Endoscopic Dcr

Dacryocystorhinostomy (DCR) is the ‘gold standard’ treatment for nasolacrimal duct obstruction (NLDO). However, despite its recent technical advancements, complications are possible. Herein, to the best of our knowledge, we present the first reported case of delayed unilateral pneumocephalus after bilateral endoscopic DCR. An 85-year-old man with bilateral NLDO underwent endoscopic DCR with silicone intubation. After 1 month, he became lethargic and was admitted to emergency room. Brain CT demonstrated left pneumocephalus and a suspected microfistula in left orbital wall. Intravenous antibiotic therapy was started, and cerebrospinal fluid studies showed no evidence of meningitis. After 13 days of antibiotic treatment, his mental state recovered with no signs of pneumocephalus. Although DCR has high success rate and is relatively safe, surgeons should be aware of the risk, although low, of pneumocephalus, especially in elderly patients who are vulnerable to fractures and who exhibit headache or mental status changes after endoscopic DCR.

scholarly journals Local Chemotherapy as an Adjuvant Treatment in Unresectable Squamous Cell Carcinoma: What Do We Know So Far?

2021 ◽  
Vol 28 (4) ◽  
pp. 2317-2325
Author(s):  
Luigi Bennardo ◽  
Francesco Bennardo ◽  
Amerigo Giudice ◽  
Maria Passante ◽  
Stefano Dastoli ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Gold Standard ◽  
Systemic Chemotherapy ◽  
Standard Treatment ◽  
Case Reports ◽  
Case Series ◽  
Surgical Removal ◽  
Local Chemotherapy

Background: Squamous cell carcinoma (SCC) is one of the most common cancers involving skin and oral mucosa. Although this condition’s gold-standard treatment is the surgical removal of the lesions, the physician must propose alternative treatments in some cases due to the patient’s ineligibility for surgery. Among the available alternative therapies, local chemotherapy may represent an initial treatment in combination with radiotherapy or systemic chemotherapy due to the low frequency of side-effects and the lack of necessity for expensive devices. Methods: In this paper, we review all available literature in various databases (PubMed, Scopus-Embase, Web of Science), proposing local chemotherapy as a treatment for cutaneous and oral SCC. Exclusion criteria included ocular lesions (where topical treatments are common), non-English language, and non-human studies. Results: We included 14 studies in this review. The majority were case reports and case series describing the treatment of non-resectable localized SCC with either imiquimod or 5-fluorouracil. We also analyzed small studies proposing combination treatments. Almost all studies reported an excellent clinical outcome, with a low risk of relapses in time. Conclusions: Resection of the lesion remains the gold-standard treatment for SCC. When this approach is not feasible, local chemotherapy may represent a treatment alternative, and it may also be associated with radiotherapy or systemic chemotherapy.

scholarly journals COVID-19 Transmission, Current Treatment, and Future Therapeutic Strategies

2021 ◽  
Author(s):  
Vrishali S. Salian ◽  
Jessica A. Wright ◽  
Peter T. Vedell ◽  
Sanjana Nair ◽  
Chenxu Li ◽  
...  
Keyword(s):  
Current Treatment ◽  
Therapeutic Strategies

Treatment of vertigo and postural instability using visual illusions

2014 ◽  
Vol 128 (11) ◽  
pp. 1005-1007 ◽  
Author(s):  
G van Kerckhoven ◽  
A Mert ◽  
J A De Ru
Keyword(s):  
Gold Standard ◽  
Prosthetic Valve ◽  
Standard Treatment ◽  
Vestibular Function ◽  
Prosthetic Valve Endocarditis ◽  
Postural Instability ◽  
Risk Of Falling ◽  
Important Advance ◽  
Dizziness Handicap Inventory ◽  
Increased Risk

AbstractBackground:Ototoxicity caused by medication can lead to debilitating symptoms such as dizziness, vertigo and postural instability. There is no current ‘gold standard’ treatment available.Case report:A 79-year-old male, with bilateral loss of vestibular function caused by gentamicin toxicity after surgery for prosthetic valve endocarditis, complained of dizziness, difficulty in walking and an increased risk of falling. Physical examination showed a positive head thrust test suggesting bilateral loss of vestibular function.Results:The patient underwent a specific motion-based virtual reality enhanced protocol for peripheral vestibular disease. He showed a great improvement, with a 50 per cent reduction in his Dizziness Handicap Inventory score.Conclusion:Computer-aided rehabilitation programmes might represent an important advance in gait and posture training.

Enhancement of Bone Implants by Substituting Nitinol for Titanium (Ti-6Al-4V): A Modeling Comparison

2014 ◽  
Author(s):  
Narges Shayesteh Moghaddam ◽  
Mohammad Elahinia ◽  
Michael Miller ◽  
David Dean
Keyword(s):  
Tumor Resection ◽  
Stress Shielding ◽  
High Strength ◽  
Standard Of Care ◽  
Mandibular Reconstruction ◽  
Bone Plate ◽  
Segmental Defect ◽  
Stress Strain ◽  
Element Analysis ◽  
Grade 5

Mandibular segmental defect reconstruction is most often necessitated by tumor resection, trauma, infection, or osteoradionecrosis. The standard of care treatment for mandibular segmental defect repair involves using metallic plates to immobilize fibula grafts, which replace the resected portion of mandible. Surgical grade 5 titanium (Ti-6Al-4V) is commonly used to fabricate the fixture plate due to its low density, high strength, and high biocompatibility. One of the potential problems with mandibular reconstruction is stress shielding caused by a stiffness mismatch between the Titanium fixation plate and the remaining mandible bone and the bone grafts. A highly stiff fixture carries a large portion of the load (e.g., muscle loading and bite force), therefore the surrounding mandible would undergo reduced stress. As a result the area receiving less strain would remodel and may undergo significant resorption. This process may continue until the implant fails. To avoid stress shielding it is ideal to use fixtures with stiffness similar to that of the surrounding bone. Although Ti-6Al-4V has a lower stiffness (110 GPa) than other common materials (e.g., stainless steel, tantalum), it is still much stiffer than the cancellous (1.5–4.5 GPa) and cortical portions of the mandible (17.6–31.2 GPa). As a solution, we offer a nitinol in order to reduce stiffness of the fixation hardware to the level of mandible. To this end, we performed a finite element analysis to look at strain distribution in a human mandible in three different cases: I) healthy mandible, II) resected mandible treated with a Ti-6Al-4V bone plate, III) resected mandible treated with a nitinol bone plate. In order to predict the implant’s success, it is useful to simulate the stress-strain trajectories through the treated mandible. This work covers a modeling approach to confirm superiority of nitinol for mandibular reconstruction. Our results show that the stress-strain trajectories of the mandibular reconstruction using nitinol fixation is closer to normal than if grade 5 surgical titanium fixation is used.

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